Evaluation of screening programmes for gynaecological cancer

Hakama, Matti; Chamberlain, Jocelyn; Day, N E; Miller, A. B.; Prorok, P. C.

doi:10.1038/bjc.1985.241

Cited by 184 publications

(117 citation statements)

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“…1,2 Nonetheless, the accuracy of this important screening tool remains controversial, with several large meta-analyses suggesting that both the sensitivity and specificity of cervical cytology is relatively low (30% to 87% sensitivity, 86% to 100% specificity). [3][4][5] As an alternative to conventional cytology, liquid based-cytology (LBC) was introduced in the mid-1990s.…”

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confidence: 99%

Direct comparison of liquid‐based and conventional cytology in a South African screening trial

Taylor

Kuhn

Dupree

et al. 2005

Intl Journal of Cancer

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Our study directly compares the performance of liquid-based (LBC) and conventional cytology for detecting high-grade cervical intraepithelial neoplasia and cancer (CIN 21) in high-risk, previously unscreened women. As part of a larger randomized clinical trial assessing the efficacy and safety of a ''screen and treat'' program for cervical cancer prevention, 5,652 South African women, aged 35 to 65 years, were screened using either ThinPrep or conventional Papanicolaou cytology. The cytology method used (i.e., ThinPrep or conventional) was rotated on a 6-month basis for the duration of the study. Directly following collection of the cytology specimen, all women underwent colposcopy with endocervical curettage and biopsy of all colposcopic abnormalities. Assessment of cytology and histology results was blinded and results were compared using histology-confirmed CIN as the ''gold standard.'' The accuracy of LBC and conventional cytology was statistically equivalent, although the sensitivity of conventional cytology was at least 5 percentage points higher at all cutoff levels. For example, at a cytology cutoff level of low-grade squamous intraepithelial lesion, the sensitivity of LBC was 60.3% for CIN21 vs. 69.1% for conventional cytology and specificity was 94.1% and 94.5%, respectively. LBC specimens were significantly less likely to be ''satisfactory-but-limited-by'' (6.5% vs. 27.9%) but significantly more likely to be unsatisfactory (2.2% vs. 0.8%). Thus, in this high-risk population, the sensitivity of LBC is no greater than the sensitivity of conventional cytology. Because of the higher unit cost of LBC, low resource settings should carefully consider the potential benefits and drawbacks of LBC before adopting this new technology. ' 2005 Wiley-Liss, Inc.Key words: cervical cytology; papanicolaou (Pap) smear; liquidbased cytology; cervical intraepithelial neoplasia Conventional cytology, i.e., the Papanicolaou smear, has been the mainstay of cervical cancer screening since the 1960s and is credited with successfully reducing the incidence and mortality of invasive cervical cancer in many developed countries. 1,2 Nonetheless, the accuracy of this important screening tool remains controversial, with several large meta-analyses suggesting that both the sensitivity and specificity of cervical cytology is relatively low (30% to 87% sensitivity, 86% to 100% specificity). [3][4][5] As an alternative to conventional cytology, liquid based-cytology (LBC) was introduced in the mid-1990s. The purported advantages of LBC include a possible increase in the detection of high-grade cervical intraepithelial neoplasia (CIN 2,3 ), a reduction in the number of unsatisfactory and ''satisfactory-but-limited-by'' specimens, and providing residual cellular material for subsequent molecular testing (e.g., testing for ''high-risk'' types of HPV DNA). On the other hand, the unit cost of LBC methods is substantially more than that of conventional cytology. The substantial increase in unit cost is of particular concern in less-developed...

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confidence: 99%

Direct comparison of liquid‐based and conventional cytology in a South African screening trial

Taylor

Kuhn

Dupree

et al. 2005

Intl Journal of Cancer

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“…These providers are then encouraged to enter the screened woman's details into a centralised database for subsequent automatic recall (every 3 years) and archiving of test results. Therefore, without explicitly anchoring the programme with proactive, personalised invitation to be screened (initial 'call' function) and direct provision of pap testing at dedicated facilities for a reasonable fee (as opposed to full market rates), it is a suboptimal arrangement by Hakama and et al's (1985) definition of an ideal programme. Nevertheless, referral for colpolscopy and subsequent management in the case of invasive disease are available in both the public and private sectors, where the former essentially provides universal access to all services with very minimal copayments (amounting to an all-inclusive per diem charge of less than d7 or $13) at the point of care.…”

Section: Discussionmentioning

confidence: 99%

Modelling the impact of population-based cytologic screening on cervical cancer incidence and mortality in Hong Kong: an age–period–cohort approach

et al. 2005

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Cervical cancer incidence and mortality statistics in Hong Kong during 1972 -2001 were examined to estimate the potential number of cancer cases that can be averted and years of life saved after the launch of an organised, population-based cytologic screening recall programme in 2004 with projections to 2016. Incidence rates under the status quo of opportunistic screening were projected by an age -period -cohort model, using maximum likelihood and Bayesian methods. Modelled rates were translated into numbers of cancer cases and deaths using mid-year population figures and age -period-specific mortality to incidence ratios. We applied International Agency for Research on Cancer risk reduction estimates for different screening strategies to these base case figures to estimate the number of incident cancers potentially averted and years of life saved attributable to organised screening incremental to the current status quo. The estimated numbers of cases projected to be preventable by the maximum likelihood (Bayesian) approach from 2002 to 2016 were 4226 (4176), 3778 (3728) and 2334 (2287) with organised screening every 1, 3 and 5 years, compared to haphazard screening currently. Correspondingly, 33 000 (32 800), 29 500 (29 300) and 18 200 (17 900) years of life could potentially be saved.

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“…The :participation rate, 88%, is among the highest reported anywhere, and the programme was successfully carried out. An organised programme (Hakama et al, 1985) was chosen because of the larger effect at lower cost and because of the possibility of more reliable evaluation as compared to opportunistic screening. The screening programme was implemented as an experiment based on municipality specific birth cohorts (Hakama, 1988).…”

Section: Discussionmentioning

confidence: 99%

“…The effect of a public health screening policy may remain low if the service is commonly available for those not invited and if the attendance remains low. This may be true rather for mammography (Andersson et al, 1988) than for pap-test for which an organised screening programme, a public health policy, is clearly superior over a spontaneous use of services (Hakama et al, 1985).…”

Section: Discussionmentioning

confidence: 99%

Breast cancer screening as public health policy in Finland

Hakama

Elovainio²,

Kajantie³

et al. 1991

Br J Cancer

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Summary A nationwide mammographic screening for breast cancer was started in Finland in 1987. During the first 2 years of the organised screening programme, 126,000 women were invited. Most of them (103,000) belonged to the birth year cohort in the 50-59 years' age groups. Among the 112,000 screenees, 418 cancers (0.4%) were found. Specificity of the test was about 96%. The screening prevalance was 2.4 times the annual incidence and a minimum estimate for the detection rate among those invited was 1.6 times that among those not invited. These estimates indicate a relatively low test and programme sensitivity. The final effectiveness of a public health policy cannot be predicted on the basis of limited preventive trials, and there is need to evaluate also a public health policy by experimental means.

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Evaluation of screening programmes for gynaecological cancer

Cited by 184 publications

References 0 publications

Direct comparison of liquid‐based and conventional cytology in a South African screening trial

Direct comparison of liquid‐based and conventional cytology in a South African screening trial

Modelling the impact of population-based cytologic screening on cervical cancer incidence and mortality in Hong Kong: an age–period–cohort approach

Breast cancer screening as public health policy in Finland

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